Patient Safety can be improved by EHRs if they are well Optimized

In order to reap rewards in quality, hospitals and health systems need to strategically pace the rollout or launch of new features and functionality

EHRs possess the ability to positively enhance patient care despite the current level of frustration among clinicians and other users. But it takes a strategic and well-thought out approach than simply implementing a new electronic health record platform or upgrading to the latest version.

Hospitals should move at a realistic and reasonable pace when rolling out baseline functions, turning on features that have matured since the initial installation, and gradually optimizing the overall functionality and user experience if they hope to achieve gains in quality and performance.

When EHRs were evolving for instance, between 2008 (when the tech was quite new) and 2013, the electronic records software went from being linked to an 11% higher 30-day mortality rate to being associated with a .09% lower rate against the same metric.

Don't expect EHRs to evolve overnight

“Healthcare is complex and so are EHRs,” said Julia Adler-Milstein, an associate professor of medicine at the University Of California San Francisco School Of Medicine. “When both are combined, they are extremely complex and the idea that we put the two together and the next day healthcare would get better was naive. For some industries, it took a decade for IT to really transform.”

Researchers used the national Medicare hospital claims data for 3,249 non-federal, acute care hospitals from 2008 to 2013, since national data only started in 2008 and several hospitals did not have a lot of EHR functionality back then. They also utilized data for 2014 from the American Hospital Association Annual Survey Database, including its Information Technology Supplement. They then created a data set that contained annual measures of hospital EHR adoption, characteristics, and mortality performance.

But they couldn’t just ask whether the EHR worked or not as they needed more specific information. So they analyzed how many baseline functions each hospital initially adopted, looked at how its EHR use and optimization progressed over and examined the pace at which new functions were adopted.

“It’s rare for hospitals to go fully paper to fully digital. More often than not, new functions are added over time. So the pace at which that happened is the third component. On the one hand, there could be an argument for moving quickly as you can to a fully digital environment because there are some risks to being partly digital and partly paper. But on the other hand you hear a lot about change fatigue and how much can an organization take on. That’s why that third piece was interesting too,” Adler Milstein said.

Indeed, as the system and its users’ adeptness at navigating the software interfaces progressed over time, study results showed that upturn to a .09 percent lower mortality rate. Logically, adding new baseline functions over time was also linked to lower mortality rates.

Why pacing new EHR functionality is critical

Average adopters, meaning those that had a baseline adoption close to the average rate of 5 functions, performed better than hospitals who didn’t adopt any, with .67 fewer deaths per 100 admissions.

The takeaway here is that hospitals and the people who work in them as well as manage them should expect performance-related gains from EHR adoption to take time. Those gains can be augmented when coupled with robust EHR support and EHR-enabled quality improvement efforts, and this should inform how many functions are adopted at first, how many are added each year, and the expectations that are reasonable to have for gauging results along the way.

The study noted that it is possible that beginning with a lot of functions or adding many new functions could have the unintended consequence of disrupting performance, as a result of change fatigue or diversion of attention away from more critical priorities.

Adler-Milstein added that it is also crucial to make sure you are constantly improving, not viewing the EHR adoption as one time thing that can be done before moving on to the next IT project.